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Depression linked to worse treatment outcomes in RA patients

medwireNews: Patients with rheumatoid arthritis (RA) have an elevated risk for psychiatric disorders, and the presence of depression is associated with a reduced likelihood of achieving a good response to biologic treatment, findings from two studies suggest.

In the first study, published in Arthritis Care & Research, Ruth Ann Marrie (University of Manitoba, Winnipeg, Canada) used population-based administrative health data covering the years 1989–2012 to analyze the occurrence of psychiatric disorders among 10,206 patients with RA and 50,960 control participants matched by age, sex, and geographic location.

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They found that patients with RA were significantly more likely to experience depression, anxiety, or bipolar disorder over the study period than controls, with corresponding incidence rate ratios of 1.46, 1.24, and 1.21 after adjustment for factors including region of residence, age, and number of physician visits. However, there was no significant difference in the incidence of schizophrenia between the two groups.

Similarly, the lifetime rates of depression and anxiety disorder were significantly higher among patients with RA than matched controls (adjusted prevalence ratios=1.35 and 1.20, respectively).

The researchers report that the incidence of depression, anxiety disorder, bipolar disorder and schizophrenia “did not change meaningfully” among RA patients and controls over the 2 decades studied, whereas the prevalence of the disorders “rose minimally.”

Together, these findings indicate that “RA is associated with an increased risk of multiple psychiatric disorders,” and “these risks have not changed over time, despite changes in the clinical management of RA over the 20-year study period,” conclude Marrie and colleagues.

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In the second study, Faith Matcham (King’s College London, UK) and team demonstrated that RA patients who have a history of depression may have a lower likelihood of having a positive outcome from biologic treatment than those without such symptoms.

As reported in Rheumatology, the 3669 patients from the British Society for Rheumatology Biologics Register with a history of depression were significantly less likely to have a good response to biologic agents (as defined by EULAR guidelines) after 1 year of treatment compared with the 14,426 patients with no history of depression, with an odds ratio of 0.80 after adjustment for potential confounders.

Experiencing symptoms of depression was also associated with reduced improvement in disease activity with biologic treatment. When the researchers analyzed the individual components of the Disease Activity Score at 28 joints, depression was associated with both subjective and objective measures of disease activity.

“There are several explanations for this novel finding,” write Matcham and colleagues. They note that “depression is known to impact health behaviours such as medication adherence,” and suggest that systemic inflammation and elevated levels of cytokines may provide a biological explanation for the association.

In light of these results, the researchers recommend that “[r]epeated screening and management of mental disorder should be undertaken as part of clinical care.”

And they conclude: “Future research examining the impact of mental health intervention for physical health outcomes may identify whether effectively managing depression can improve treatment response in RA.”